Level of consciousness (GCS)

Glasgow Coma Scale, Head Injury, Traumatic Brain Injury

1. LEVEL OF CONSCIOUSNESS Recognition and Management By GBONEME S.E

2. OUTLINE INTRODUCTION DEFINITION OF TERMS AEITIOLOGY PATHOPHYSIOLOGY GLASGOW COMA SCORE INVESTIGATION MANAGMENT

3. INTRODUCTION

4. INTRODUCTION Contd Level of consciousness (LOC) is a measurement of a person's arousability and responsiveness to stimuli from the environment. Altered consciousness is one of the most common findings encountered by a neurosurgeon. Altered level of consciousness is a condition of being less responsive to and aware of external stimuli

5. Definition of Terms CONFUSED: disoriented to surroundings, may have impaired judgment, may need cues to respond to commands. LETHARGIC: Drowsy, needs gentle verbal or touch stimulation to initiate response. OBTUNDED: responds slowly to external stimulation and needs repeated stimulation to maintain attention and response STUPOROUS: responds only minimally with vigorous stimulation, may only moan as a verbal response COMATOSE: no observable response to any external stimuli

6. AEITIOLOGY Structural Trauma: cerebral edema, subdural and epidural hematoma . Vascular: subarachnoid hemorrhage, infarction. Infection: meningitis, encephalitis, brain abscess. Neoplasms: metastatic tumor, primary brain tumor

7. AEITIOLOGY Contd : Metabolic: Toxicity: drugs (opiates), heavy metals, carbon monoxide Systemic metabolic derangement: hypoglycemia, hyponatremia , diabetic ketoacidosis, hyperglycemia Extremities of body temperature: Heat stroke, hypothermia Hypoxic encephalopathy: severe anemia, severe pulmonary disease, severe heart failure.

8. PATHOPHYSIOLOGY Cellular brain edema or a disrupted chemical transmission at the receptor site results in faulty impulse transmission and impending communication within the brain or from the brain to other body parts.

9. Glasgow Coma Scale Glasgow Coma Scale  ( GCS ) is a  neurological   scale  which aims to give a reliable and objective way of recording the conscious state of a person for initial as well as subsequent assessment. It is also useful in the classification of head injury

10. CONTD: A patient is assessed against the criteria of the scale, and the resulting points give a patient score between 3 (indicating deep unconsciousness) and 15. A score of 15/15 with no LOC – Mild head injury 14/15 or15/15 with LOC – Minor head injury 9 -13/15 – Moderate head Injury 3-8/15 – Severe head injury

11. PHYSICAL EXAMINATION

12. INVESTIGATIONS Complete blood count ( Rule out severe anemia evidenced by low RBC’S, decreased PCV. Also, infection, evidenced by elevated WBC’s and differentials). Blood Glucose ( Rule out Hypo/Hyper glycaemia) Electrolytes/ Urea/ Creatinine (Rule out electrolyte derangement as well as uremic encephalopathy) Imaging Studies : X-ray CT-SCAN MRI

13. RESUCUITATION The A..B..C..D’s A- Airway: Stabilize Neck Ensure Airway is patent Suction if necessary Use of Airway adjunct. Use of endotracheal tube if indicated B- Breathing; Use of mechanical ventilator is used to maintain adequate oxygenation

14. CONTD Circulation Monitor circulatory status using the following parameters. Blood pressure, heart rate. Ensure adequate perfusion to body and brain. Pass an intravenous catheter to provide fluid access Give adequate intravenous medications Determine and treat the underlying cause of the LOC